America's Arab Refugees

Vulnerability and Health on the Margins

Marcia C. Inhorn

• Publisher: Stanford University Press
• Year: 2018
• ISBN:
  9781503604384
• Edition: 1
• Topic: Sciences sociales
• Subtopic: Anthropologie

America's Arab Refugees is a timely examination of the world's worst refugee crisis since World War II. Tracing the history of Middle Eastern wars—especially the U.S. military interventions in Iraq and Afghanistan—to the current refugee crisis, Marcia C. Inhorn examines how refugees fare once resettled in America.

In the U.S., Arabs are challenged by discrimination, poverty, and various forms of vulnerability. Inhorn shines a spotlight on the plight of resettled Arab refugees in the ethnic enclave community of "Arab Detroit, " Michigan. Sharing in the poverty of Detroit's Black communities, Arab refugees struggle to find employment and to rebuild their lives. Iraqi and Lebanese refugees who have fled from war zones also face several serious health challenges. Uncovering the depths of these challenges, Inhorn's ethnography follows refugees in Detroit suffering reproductive health problems requiring in vitro fertilization (IVF). Without money to afford costly IVF services, Arab refugee couples are caught in a state of "reproductive exile"—unable to return to war-torn countries with shattered healthcare systems, but unable to access affordable IVF services in America. America's Arab Refugees questions America's responsibility for, and commitment to, Arab refugees, mounting a powerful call to end the violence in the Middle East, assist war orphans and uprooted families, take better care of Arab refugees in this country, and provide them with equitable and affordable healthcare services.

1

Why They Fled

War and the Health Costs of Conflict

Syndemics and War Stories

For those of us who have never lived through a war, it is hard to imagine what it would be like. Bombings, sniper fire, land mines, abductions, hunger, house raids, torture, rape, flying shrapnel, lack of water and electricity, imprisonment, loss of life and limb. These are the kinds of horrors that war inflicts on human beings, both combatants and civilians. In the twentieth century, it is estimated that 45 million combatants and 62 million civilians died as a result of war—not only because they were killed outright but because diseases and other forms of death took even more lives than battlefield injuries.¹

War damages human health in multiple ways, both during and after conflict. The health costs of war tend to co-occur, interacting synergistically to cause “syndemics,” or simultaneous epidemics of human suffering. To take but one example, epidemics of malnutrition and infectious disease often go hand in hand during wartime because food shortages and unsanitary living conditions take their toll on human populations, especially those fleeing to makeshift refugee camps. Medical anthropologists Bayla Ostrach and Merrill Singer call these synergistic interactions of war-related morbidity and mortality the “syndemics of war.”² As they note,

War, by causing physical and emotional trauma in populations, destroying healthcare systems and social infrastructures, despoiling the environment, intentionally or unintentionally causing or exacerbating food insecurity and malnutrition, creating refugee populations, and spreading infections (e.g. through the movement of troops, dislocation of civilian populations, changes in the environment) promotes the development of syndemics.³

In this chapter, I explore the syndemics of war in the Middle East, particularly in the two Arab countries of Lebanon and Iraq, where most of the people I met in Arab Detroit had once lived. This chapter takes us back to their home countries, asking: What happened there? What forced these Lebanese and Iraqi people to flee for their lives? As we will see, the health costs of war in both Lebanon and Iraq have been profound, leading to trails of human misery. In Lebanon, for example, the death or flight of more than one-third of the country’s entire population led to serious demographic consequences and reproductive disruptions, the results of which are still being felt in that country today. In Iraq, co-occurring epidemics of cancer and birth defects have emerged, likely as a result of wartime environmental contamination.⁴ In fact, an ongoing controversy over the US military’s use of depleted uranium (DU) in Iraq suggests that war may be literally “toxic,” with human health consequences lasting for decades, even future millennia.

In my own study in Arab Detroit, il harb, “the war,” was on the minds of many of my interlocutors. Nearly one-third of the Lebanese I met, and almost all of the Iraqis, had come to the United States to escape the wars in their home countries. Their war stories, some of which they shared with me, could only begin to convey the human suffering.

Mahmoud

Mahmoud was twenty-six and living in southern Lebanon when Israeli troops invaded his village. Not yet understanding the gravity of the situation, Mahmoud attempted to make an escape in his car, running directly into an Israeli tank. The tank charged his vehicle, pushing it off the road into a deep ravine. Mahmoud was crushed under the weight of his own automobile, sustaining massive internal injuries—a punctured liver and bladder, a broken back, dislocated shoulders, dislocated hips, and the breaking of every single rib in his body. However, Mahmoud was not left to die by the Israeli soldiers, who deposited his broken body in a nearby hospital. Although the doctors predicted that Mahmoud would die on the operating table, he lived. And, after months of painful recovery, Mahmoud’s relatives in the United States were able to fly him to America for long-term physical therapy and rehabilitation.

By the time I met Mahmoud in an Arab Detroit IVF clinic, he had resettled in the United States, where he was receiving Supplemental Security Income (SSI) because of his painful disabilities. Still in his mid-thirties, Mahmoud looked like a much older man, silver-haired and walking irregularly with a cane, because one of his legs was now two inches shorter than the other. In private, Mahmoud also told me that he had lost his bladder control and was diagnosed with a very, very low sperm count, making him unable to impregnate his wife of six years.

Mayada

Mayada, who hailed from Lebanon’s Greek Orthodox community, was stuck in Beirut’s war zone for nearly a dozen years because her parents were unable to secure the resources to escape with their five children and several grandchildren. Mayada did not blame her parents. As she put it, “My parents worked very hard, very hard to keep us alive.” However, their twenty-one-year-old son, who had spent most of his childhood and youth in Beirut’s war zone, was eventually shot and killed by a sniper. Within weeks, the family’s second eldest child, a daughter aged thirty-four, was also killed by a sniper. Her death was especially painful because she had just been visiting her older sister, who had given birth to a baby daughter. The senseless deaths of two of their five children devastated Mayada’s parents, who finally secured passage to Greece for the remaining family members. Following their escape, a family member in the United States sponsored their move to America. They ended up settling in Arab Detroit, along with many other exiled Lebanese who had fled from Beirut’s war zone.

When I met Mayada, she conveyed to me how her family was still haunted by the war. Mayada herself was adamant that she would never ever return to her home country or put her own daughter in harm’s way. She also told me that her mother and older sister were “broken” people, unable to overcome their guilt and anguish. As Mayada explained,

It’s very hard for my mother. Those were her children, her own blood. All her life was affected by this. Even now my mother still suffers from this, and she takes antidepressant medicines in order to function. But you should see my sister. She looks older than my mom. She’s the one who had the baby, and she keeps saying, “If the baby was not born there, she [our sister] would still be doing something; she would still be alive.” My sister has severe depression. I told her to go to the pharmacy and get some medicine. Even take a walk around the block. “Just walk!” But she stays in the house all the time and is very, very sad. Even though we tell her that we have to get over it—“Forget the past”—this happened to her, and she can’t live with it. Even if a war stops, a lot of bad memories remain.

Kamal

Bad memories also haunted Kamal, an Iraqi refugee who had become a small business owner in Arab Detroit. Although he was happily married and relatively successful by community standards, Kamal’s experiences as a soldier in the Iran–Iraq War, as well as his participation in the Shia intifada against Saddam Hussein, had stayed with him, physically and emotionally, over many years. As Kamal told me,

I was a telecommunications specialist in the Army. But I was in a tank, always in a tank. I saw everything! The smells, the dead people. Sometimes we were sleeping with people who were dead in the tanks, injured people, with blood all around. We saw everything! So when we see [that] someone is dead, we don’t even care. We saw so many dead people, so much blood. Sometimes, we had to eat with people who were dead beside us. And while we were fighting, Saddam was using chemicals [that is, weapons]. But I didn’t smell it. And then we heard that there is [radioactive] uranium everywhere. You know, Marcia? Cancer. A lot of people in Iraq got cancer. If you ask anybody here, “You got the flu?,” the question there would be, “You got cancer?” Before, it was not easy to use the term saratan [cancer]. But now, it’s easy to say, “I got cancer.” My sister, she had a sixteen-year-old daughter. She died after two months from cancer, liver cancer. She found out, and then she died.

But, Marcia, I want to tell you something about me. I have no problem with sex, no problem with my body. I don’t smoke, no drinking. I do exercise every day, and I’m healthy. But I know a lot of [Iraqi] men like me. They don’t have kids, and they take a long time to get a baby. I know about fifteen to twenty people like that, here in Michigan. Some are friends of mine. We are all refugees. The 1990 revolution, we did it against Saddam! And so we had to live in refugee camps in Saudi Arabia, where the conditions were very bad. It was in the middle of the desert, always dusty, and the water was not good. The tea would turn white because the water was salty, and the soap sticks to your hands.

All of us Iraqi refugees, the same life we lived. The same war. The same camp. The same thing. And we began talking about the subject of [not getting] babies. I always tell them, “We don’t want to be shy [about this] because we need a baby! Don’t be shy! Go to the doctor. Don’t stay at home. Tell him [the doctor], ‘I’m sick, and I need to take medicine.’” I know somebody [with male infertility], and he was ready to make a divorce with his wife, and he’s young! But I tell him, “Please don’t do that! Go to the doctor. Do something!” In Iraq, we lost all our good doctors. But here in America, everything is good. The doctor is good. Technology is good. Medicine is good. But some men, they’re embarrassed to say, “I have this problem.” It’s the rujula, the “manhood.” But this is wrong.

The Health Costs of Conflict

Mahmoud, Mayada, and Kamal all speak to the damage that war inflicts on human health. Kamal’s story in particular points to the syndemic nature of long-term war in Iraq, where death, environmental contamination, cancer, refugeeism, and reproductive disruption are synergistically interconnected in his narrative. In addition, it is clear from these war stories that war disrupts the lives of four different groups of people—those who actually fight wars (combatants, including soldiers and militia members); refugees and internally displaced persons; those left behind (mostly women, children, and the elderly); and health care professionals. Wars create chaos, both personal and social, for individuals and for societies at large. Using the powerful metaphor of “disrupted lives” as a framework for understanding, it is evident that war disrupts human lives on both the individual and societal levels, per the metaphor of disruption forwarded by medical anthropologist Gay Becker:

In all societies, the course of life is structured by expectations about each phase of life, and the meaning is assigned to specific life events and roles that accompany them. When expectations about the course of life are not met, people experience inner chaos and disruption. Such disruptions represent loss of the future. Restoring order to life necessitates reworking understandings of the self and the world, redefining the disruption and life itself.⁵

Beyond the lives disrupted by war, war militates against the achievement of human health. In a historic conference convened by the World Health Organization (WHO) in the Central Asian city of Alma-Ata, Kazakhstan, in September 1978, health was famously defined in a ten-point charter called the “Declaration of Alma-Ata.” Article I of the declaration states:

The Conference strongly reaffirms that health, which is a state of complete physical, mental, and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.

In other words, the Declaration of Alma-Ata contends that health is a human right and that the achievement of “health for all” should be an important global priority. However, the declaration ends with a stern warning about the mistaken misdirection of valuable health resources toward military spending. Article X cautions:

An acceptable level of health for all the people of the world . . . can be attained through a fuller and better use of the world’s resources, a considerable part of which is now spent on armaments and military conflicts. A genuine policy of independence, peace, détente and disarmament could and should release additional resources that could well be devoted to peaceful aims and in particular to the acceleration of social and economic development of which primary healthcare, as an essential part, should be allotted its proper share.⁶

In other words, the first and last articles of the Declaration of Alma-Ata point to a fundamental conflict: As long as wars are being waged around the world, global health will never be achieved. Wars make the Alma-Ata goal of “health for all” impossible, not only because of the morbidity and mortality that wars inflict but also because wars lead to a crucial misallocation of funding away from health and toward military spending.

What does war “cost” in terms of human health? War affects population health in six important ways:⁷ physical (the years of healthy life lost to sickness, disability, and death); mental (the increase in psychological disorders resulting from war-related “triggers”); reproductive/demographic (the increased reproductive and sexual vulnerability of women, the exodus and death of men, the orphaning of children, and long-term demographic shifts); social structural (the loss of social safety nets, increased po...